Cardiopulmonary Resuscitation 2010 Update
Below are the Pediatric highlights:
- 5-15% of pediatric arrests are V.Fib: Peds arrest is primarily due to a respiratory insult (we are aware of this).
- The adult paradigm is no longer “ABC”, but rather “CAB” (Chest Compressions, Airway, then Breathing)… and, despite the fact that Peds arrests are still most likely respiratory, the Pediatric model will also now be “CAB.” This is primarily to help with pre-hospital care and layperson education. You should still know that the “A” and the “B” are still very important!
- Pulse checks are deemphasized (if you can’t feel a pulse in 10 seconds, start chest compressions). Chest compressions with a beating heart are found to be better than no chest compressions with no beating heart (which is suboptimal).
- AHA recognizes that cuffed endotracheal tubes in infants and young children are safe and effective (glad they agree with us).
- Cricoid pressure may impede ventilation and worsen your view during intubation. It should be modified or discontinued if this is the case (again, glad they agree with us).
“The optimal energy dose required for defibrillation (using either monophasic or biphasic waveform) in infants and children is unknown. When shocks are indicated for VF or pulseless VT in infants and children, and initial energy dose of 2 to 4 J/kg of either waveform is reasonable; doses higher than 4 J/kg, especially if delivered with a biphasic defibrillator, may also be safe and effect.” –direct quote.
- Etiology is nearly always a respiratory insult; therefore, the paradigm is still “ABC.”
- Resuscitate with room air rather than 100% oxygen. Any supplemental oxygen should be regulated with a blender. Recall that even healthy newborns may take up to 10 minutes to increase their saturations from 60% to >90%. Oxygen should be considered a medication in all ages and used appropriately.
- Chest compression : Ventilation ratio = 3:1 (since ventilation is critical). If a cardiac lesion is known to be the etiology, than 15:2 should be considered.
- “In a newly born baby with no detectable heart rate that remains undetectable for 10 minutes, it is appropriate to consider stopping resuscitation.”
American Heart Association. Part 1: executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, Vol. 122, Issue 18, Suppl 3; Novemeber 2, 2010.